WHAT'S UP DOC? E-cigarettes are just as damaging

By Dr. Jeff Hersh/Daily News Correspondent

Wednesday

Oct 3, 2018 at 10:07 AMOct 3, 2018 at 5:31 PM

Q: Is it true that e-cigarettes are safe?

A: In 1965 about 40 percent of Americans smoked; this has thankfully decreased to about 18 percent today. But 18 percent is still extremely high, and despite this decrease smoking is still the leading cause of preventable death in the United States, causing almost half a million deaths (one in every five) every year.

Electronic cigarettes (e-cigarettes) have a battery that heats up an "e-liquid" that contains nicotine (which is extracted from tobacco), turning it into a vapor which is then inhaled. Vaping (inhaling the smoke from) electronic cigarettes was created as a tool to deliver nicotine to smokers to help them quit smoking (a similar approach to nicotine patches and nicotine gums) in a way that mimics smoking (in that e-cigarettes are designed to look and be "smoked" similar to a "regular" cigarette). In 2016 the FDA finalized a rule to regulate all tobacco products, including e-cigarettes.

The idea of e-cigarettes is to deliver nicotine to smokers without also delivering some of the other harmful chemicals that are in regular cigarette smoke. Although e-cigarettes were initially touted as being safe, this turns out not to be the case. Although potentially less carcinogenic than regular cigarettes, e-cigarettes are still known to contain many toxic and carcinogenic substances. For example, e-cigarette vapors may contain formaldehyde, acetaldehyde, benzene, certain metals (including nickel, chromium and manganese), as well as other potentially toxic substances.

There is not yet as extensive data on the health effects of e-cigarettes as there is for regular cigarettes, but evidence already links e-cigarette smoking to multiple health issues, including impaired wound healing, breathing issues (for example chronic obstructive lung disease or COPD, smoker’s cough and others), high blood pressure, and other adverse health effects. Even if vaping is safer than smoking, say 75 percent safer as has been suggested by some e-cigarette advocates, if all smokers became vapers this could eventually translate to over 125,000 deaths per year (a quarter of the deaths now attributed to smoking regular cigarettes).

Unfortunately, e-cigarettes are already being misused, i.e., not used only to aid in quitting cigarette smoking. Many people who have never smoked cigarettes are starting to "smoke" using e-cigarettes. Almost 10 million Americans are now regular vapers. In fact, sales of e-cigarettes are expected to be over 3.5 billion (yes with a “b”) dollars this year in the U.S. and over 80 billion worldwide.

Furthermore, flavored e-cigarettes may be enticing younger people to "try it;" this is true for children as well, especially when flavors such as milkshake, cookie, strawberry, cherry, vanilla and others that are now marketed are considered. Almost 10 percent of eighth-graders have tried vaping, and this number goes up to 20 percent or higher by senior year in high school.

Vapers are exposed to nicotine, which is known to be highly addicting. The nicotine addiction has caused some vapers to begin the practice of "dripping," where they take the outside cover off their e-cigarette and drip some of the liquid directly onto the device’s coil in order to increase the amount of nicotine they get from each puff. Even more worrisome, as people become "hooked" on nicotine many progress from e-cigarettes to regular cigarettes. One study noted that kids who vape are six times more likely to become smokers. So rather than helping people quit smoking, vaping may be contributing to increases in smoking.

If you smoke, quitting is one of the best health decisions you can make. However, e-cigarettes have yet to be proven to be a useful quitting aid, and they are already being misused as an alternative way to smoke, with many health hazards already identified. Add to that the potential for getting children addicted to nicotine, and you can see that e-cigarettes may be a developing health care issue. Hopefully they will soon be regulated more aggressively by the FDA, which is considering regulating e-cigarettes as an over-the-counter drug. In the meantime, people should use considerable caution in making a decision whether or not to use e-cigarettes, and I would strongly urge people who do not smoke not to start, whether with regular cigarettes or e-cigarettes.